Topping the list in sugar diet, India has emerged as the world's diabetic capital, striking the young and pushing up treatment costs sharply

By Damayanti Datta

PICTURE SPEAK

REACHING OUT: A diabetes awareness camp in Chennai

Begin on the ground floor. A stony-faced young man is talking to endocrinologist, Dr Shashank Joshi. The knuckles of his clasped hands stand out white as he falters over the trauma turning his placid, middle-class existence upside-down: failure to consummate his new marriage. "Nothing wrong with your hormones," Joshi breaks the news gently, "but plenty with the sugar in your blood. You have diabetes and that's your problem."

One floor up, ICU: a man waits for an angioplasty. Sixth floor: kidney patient. Eighth floor, corner room: stroke. Two doors down: woman with toes sawed off. Next room: nerve damage. Beds at the Lilavati Hospital, Mumbai, are filled with a universe of afflictions, as always. But nearly half the assorted ailments are the work of a single illness: diabetes-the chronic metabolic disorder which allows excess sugar to build up in the blood and inflicts ferocious damage throughout the body.

Lilavati tells the sad tale of India today. On the eve of the World Diabetes Day (November 14), the country has emerged as the world's diabetes capital. One in every five diabetics in the world is an Indian, according to the World Health Organization. Medics describe the problem as a bona-fide epidemic: it is growing fast-from an estimated 19.4 million in 1995 to the present 35 million-both in the number of new cases and people it kills. In the cities it has become such a fact of life-with 8 per cent to 14 per cent falling prey-that people describe it casually, almost comfortably, as "getting the sugar". Chennai has one of India's highest concentrations, with 16 per cent adult diabetics-triple the rate two decades ago, according to a recent study. But alarmed as medics are about the present scenario, they worry more about what is to come. In 20 years, India may have 75 million diabetics, say experts.

A SWEET TOOTHIndians are gorging on fat-rich, fast food

India tops the world in sugar diet.

Semi-processed/cooked/ready-to-eat sector growing at 22 per cent.

Indian snack food market is one of the largest in the world.

A BITTER TASTE High-calorie intake is boosting diabetes

Every fifth diabetic in the world is an Indian.

India now has 35 million diabetics.

Treatment cost per person has touched Rs 14,000 annually.

A BLEAK FUTUREChecking it could well be an uphill task

Indians are genetically predisposed toward diabetes.

'Syndrome X' is rising in India.

Once a disease of the old, it is now striking younger people.

Source: International Diabetes Federation 2006 and FICCI

Sugar is the operative word. India tops the world in sugar consumption. Sweets are obligatory at all social occasions and the ubiquitous sweet shops form the biggest sector (Rs 57,750 crore) in the country's food and beverages industry, says the FICCI Food and Beverages Survey 2006. What's more, sugar in Indian diet has more than doubled since the 1980s, reports the UN. Delhiites consume 40 per cent more sugar than they did 50 years back. Dr V. Mohan, chairman of the Diabetes Specialities Centre and the man who has started the 'Diabetes Movement' in Chennai, grasped the ferocity of India's craving for sweets the hard way. "I had nearly provoked a rebellion in Chennai by forgetting to serve sweets at a business conference once," he recalls.

But tackling the sugar onslaught is not that simple. Foods just need to have more than 10 per cent sugar to be perilous. And sugar hides in all sorts of unexpected places. Savoury foods, for instance, are a surprising source of those extra grammes. As India blitzes through urbanisation and modernisation, store shelves fill up with mass-produced, tasty food, packed with calories, more people eat at restaurants, grab takeaways or buy frozen stuff to heat up at home. India's fast-food industry is growing at 40 per cent a year, according to the US-based Worldwatch Institute. The snack food market is one of the largest in the world. The ready-to-eat sector is growing at a startling 22 per cent. "Diabetes is the price you pay for progress," says Dr Anoop Misra, head of metabolic disorders at Fortis Hospital, Delhi.

No wonder, Syndrome X is on the rise, too. Coined by Stanford researchers in 1988, it indicates a group of risk factors that significantly hikes the chances of contracting diabetes. "When people abandon their traditional, balanced diets, they often become victims of Syndrome X," adds Misra. No wonder, 25 to 40 per cent urban Indians are believed to be afflicted by it. The symptoms are common enough: gaining a kg here and there and having trouble losing it, feeling hungry even after a meal, being sluggish regardless of how much one sleeps, craving for sweets. They indicate insulin resistance and high blood pressure, among other things. "Those who get it usually do not show any symptoms for years, and many have a hard time believing they are truly ill," says Misra. In a study conducted by the Escorts Heart Institute, 29 per cent of corporate executives surveyed in Delhi showed indications of the disease.

HOW THE SUGAR MILL WORKS Rising blood sugar clogs the body's mechanisms and disrupts the basic functions of vital organs with fatal consequences

1 Stomach: Carbohydrates from food are broken down into glucose to provide energy to cells. Glucose, soaked up from the intestines into the blood, travels to the liver and other organs.

2 Liver: The liver is programmed to release a certain amount of glucose into the blood and save the rest for future use.

3 Pancreas: Rising levels of glucose in the blood trigger the pancreas to secrete insulin into the bloodstream.

4 Body cells: The insulin 'key' must fit into a cell's insulin receptor 'lock' for glucose to get inside the cell. In diabetes, glucose cannot enter the cells and builds up in the blood.

"Genetically, too, Indians are predisposed toward diabetes," says Dr Shaukat Sadikot, endocrinologist at Jaslok Hospital in Mumbai. A slew of research studies reveals that in comparison to Caucasians, insulin resistance and heart diseases are more common among Indians. They also seem to catch the disease about 10 years earlier. Moreover, new sub-groups are coming to light. "Diabetes retains an outdated reputation as a sickness of the old," points out Mohan. But it is striking younger people now. And because India is so youthful-half the population is under 25-the future of diabetes appears all the more chilling.

The disease has no cure. It is progressive and often fatal, and while the patient lives, the welter of medical complications it sets off can attack every major organ. It is also an expensive disease. A study by the Postgraduate Institute of Medical Education and Research, Chandigarh, shows that middle-class diabetics often exhaust a quarter or more of their income on medication and care. The cost of care per person annually has gone up from around Rs 3,000 in the early 1990s to Rs 14,508 at present.

While the Health Ministry gears up for a national crusade, the disease continues to wreak havoc. Consider Asha Desai. The strapping commerce student of Ahmedabad had to be hospitalised with sudden diabetes at the age of 22. She now takes two insulin shots every day. But injections have made little difference. She spent the last one year being admitted and then discharged from the hospital seven times, running up a bill of more than Rs 2 lakh. She got back home last week. "But she has come back a different person," her mother says, "Asha doesn't smile anymore."